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Background <p>Anastomotic leakage (AL) is a serious complication after colorectal cancer (CRC) surgery. Preoperative insulin resistance (IR) may impair anastomotic healing, but there is limited evidence regarding currently available surrogate markers of IR.</p> Methods <p>In this multicenter retrospective cohort study conducted across three tertiary institutions between 2019 and 2024, 1,026 patients who underwent CRC resection with primary anastomosis were analyzed, of whom 128 (12.5%) developed AL. Preoperative IR was assessed with the use of the homeostasis model assessment of insulin resistance (HOMA-IR) and the triglyceride-glucose (TyG) index. The associations were evaluated using multivariable logistic regression adjusting for demographic, clinical, tumor-related, operative, and laboratory covariates. The TyG index cut-off was derived using receiver operating characteristic (ROC) analysis and internally validated using bootstrap resampling and cross-validation.</p> Results <p>Patients with AL had higher fasting insulin and HOMA-IR, and IR was more common in the AL group (60.9% vs. 31.1%). The TyG index was also higher in patients with AL, and TyG index ≥ 8.51 was more frequent in the AL group (63.3% vs. 45.5%). In multivariable logistic regression, HOMA-IR ≥ 2.5 (OR 2.95, 95% CI 1.75–4.16) and TyG index ≥ 8.51 (OR 1.58, 95% CI 1.08–2.09) remained independently associated with AL after adjustment for relevant demographic, tumor-related, operative, and laboratory covariates.</p> Conclusions <p>Preoperative HOMA-IR and TyG index were associated with an increased risk of AL after CRC resection. Further prospective and externally validated studies are needed before routine clinical application can be considered.</p> Trial registration <p>Retrospectively registered.</p>

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Association of preoperative insulin resistance surrogate indices with the risk of anastomotic leakage after colorectal cancer resection: a multicenter retrospective cohort

  • 期刊论文

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  • 发表日期：

    2026年4月23日

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  • Mohammadsadra Shamohammadi,
  • Hamid Reza Mohammadi,
  • Mohaddeseh Karami Porrzani,
  • Marina Yiasemidou,
  • Adnan Tizmaghz,
  • Mansour Bahardoust

摘要

Background

Anastomotic leakage (AL) is a serious complication after colorectal cancer (CRC) surgery. Preoperative insulin resistance (IR) may impair anastomotic healing, but there is limited evidence regarding currently available surrogate markers of IR.

Methods

In this multicenter retrospective cohort study conducted across three tertiary institutions between 2019 and 2024, 1,026 patients who underwent CRC resection with primary anastomosis were analyzed, of whom 128 (12.5%) developed AL. Preoperative IR was assessed with the use of the homeostasis model assessment of insulin resistance (HOMA-IR) and the triglyceride-glucose (TyG) index. The associations were evaluated using multivariable logistic regression adjusting for demographic, clinical, tumor-related, operative, and laboratory covariates. The TyG index cut-off was derived using receiver operating characteristic (ROC) analysis and internally validated using bootstrap resampling and cross-validation.

Results

Patients with AL had higher fasting insulin and HOMA-IR, and IR was more common in the AL group (60.9% vs. 31.1%). The TyG index was also higher in patients with AL, and TyG index ≥ 8.51 was more frequent in the AL group (63.3% vs. 45.5%). In multivariable logistic regression, HOMA-IR ≥ 2.5 (OR 2.95, 95% CI 1.75–4.16) and TyG index ≥ 8.51 (OR 1.58, 95% CI 1.08–2.09) remained independently associated with AL after adjustment for relevant demographic, tumor-related, operative, and laboratory covariates.

Conclusions

Preoperative HOMA-IR and TyG index were associated with an increased risk of AL after CRC resection. Further prospective and externally validated studies are needed before routine clinical application can be considered.

Trial registration

Retrospectively registered.